Thank you for your question and for providing some background on your previous treatments. It's great that you're exploring various options to address the deepened lines around your mouth, loss of volume, and jowls. Here’s an overview of the treatments you mentioned and some additional insights: Thermage Indication: Thermage uses radiofrequency energy to stimulate collagen production and tighten the skin. Effectiveness: It can be effective for mild to moderate skin laxity and early signs of jowls, and it may help soften lines around the mouth. Consideration: Results can vary, and maintenance treatments are often needed. It's a non-invasive option with minimal downtime. Fraxel Indication: Fraxel is a fractional laser that targets aging and sun damage by promoting the skin’s natural healing process. Effectiveness: It can improve skin texture, reduce fine lines, and enhance skin tone. It’s particularly effective for surface-level imperfections. Consideration: There is some downtime, typically involving redness and peeling for a few days post-treatment. Morpheus8 Indication: Morpheus8 combines microneedling with radiofrequency energy to target deeper layers of the skin, promoting collagen and elastin production. Effectiveness: It can improve skin texture, tighten the skin, and reduce the appearance of fine lines and mild jowls. Consideration: Multiple sessions are often recommended for optimal results. Since you had this treatment once last year, additional sessions may further enhance your results. Sculptra Indication: Sculptra is a dermal filler that stimulates collagen production, providing gradual and natural-looking volume restoration. Effectiveness: It is beneficial for addressing volume loss and enhancing facial contours over time. Consideration: Results develop gradually over several months, and multiple sessions are usually required. Additional Recommendations Combination Approach: Often, combining treatments yields the best results. For example: Thermage or Morpheus8 for skin tightening. Fraxel for improving skin texture and reducing fine lines. Sculptra or other fillers for volume loss. Consult with a Board-Certified Dermatologist or Plastic Surgeon: Seek a practitioner who listens to your concerns and offers a range of treatments. Someone with extensive experience in facial rejuvenation can tailor a treatment plan specific to your needs. Topical Treatments: Retinol: Encourages cell turnover and can improve skin texture and fine lines. Vitamin C Serum: Acts as an antioxidant, brightens the skin, and improves collagen production. Maintenance and Lifestyle: Regular maintenance treatments, a healthy lifestyle, and proper skincare can prolong the effects of these procedures. Conclusion Each of these treatments has its own benefits and considerations. A personalized consultation with a reputable and experienced provider will help tailor a treatment plan that best suits your needs and aesthetic goals. I hope this information helps you make an informed decision. Best of luck on your journey to rejuvenation! Best regards,